Miyake Hiromu, Seo Shogo, O'Connell Joshua S, Janssen Lok Maarten, Pierro Agostino
General and Thoracic Surgery, The Hospital for Sick Children, University of Toronto, 1526-555 University Ave, Toronto, ON, M5G 1X8, Canada.
Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka, 4208660, Japan.
Pediatr Surg Int. 2019 Jan;35(1):107-116. doi: 10.1007/s00383-018-4381-7. Epub 2018 Nov 3.
Recently, plastic closure of abdominal defect in infants with gastroschisis has been used. Timing of gastroschisis closure can be mainly divided into two groups: primary closure and delayed closure after silo forming. Safety and usefulness of plastic closure in gastroschisis remains unclear. We aimed to evaluate the current evidence for plastic closure in infants with gastroschisis.
The analysis was done for primary closure as well as closure after silo. Outcomes were mortality, wound infection, duration of ventilation, time to feeding, and length of hospital stay (LOS). The quality of evidence was summarized using the GRADE approach.
In the "primary" group, there was no significant difference in mortality, time to feeding initiation and LOS. In the "silo" group, wound infection was significantly lower in plastic closure (Odds ratio 0.24, 95%CI 0.09-0.69, p = 0.008). Duration of ventilation, time to feeding initiation and LOS were significantly shorter after plastic closure (Ventilation; mean difference (MD) - 5.76, p = 0.03. Feeding initiation; MD - 9.42, p < 0.0001. LOS; MD - 14.06, p = 0.002). Quality of evidence was very low for all outcomes.
Current results suggest that plastic closure may be beneficial for infants with gastroschisis requiring silo formation. However, this evidence is suboptimal and further studies are needed.
最近，已采用塑料闭合术治疗腹裂婴儿的腹部缺损。腹裂闭合的时机主要可分为两组：一期闭合和在放置肠袋后延迟闭合。塑料闭合术治疗腹裂的安全性和有效性仍不明确。我们旨在评估目前关于腹裂婴儿塑料闭合术的证据。
对一期闭合以及放置肠袋后的闭合情况进行分析。观察指标包括死亡率、伤口感染、通气时间、开始喂养时间和住院时间（LOS）。采用GRADE方法总结证据质量。
在“一期”组中，死亡率、开始喂养时间和住院时间无显著差异。在“肠袋”组中，塑料闭合术的伤口感染率显著较低（比值比0.24，95%可信区间0.09 - 0.69，p = 0.008）。塑料闭合术后通气时间、开始喂养时间和住院时间显著缩短（通气；平均差（MD）-5.76，p = 0.03。开始喂养；MD - 9.42，p < 0.0001。住院时间；MD - 14.06，p = 0.002）。所有观察指标的证据质量都非常低。
目前的结果表明，塑料闭合术可能对需要放置肠袋的腹裂婴儿有益。然而，这一证据并不理想，需要进一步研究。
